Venous Anatomy for Wednesday, June 17th, 2026

Contributed by Cincinnati Children's Hospital
Neil Johnson.

History

Patient with complex cardiac and other anomalies

Left Upper Limb PICC placed and tip was initially to the LEFT of the spine

Contrast was administered and the image shows the contrast fluoro image

Images (Click any image to enlarge)

Initial Fluoro PICC tip position

Question

What vascular anomaly is shown in this case?

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Correct answer

Retro-Aortic Left Brachiocephalic Vein

Discussion

This is a very rare venous anomaly...

The abnormal left brachiocephalic vein passes posterior to the aorta (normally passes anterior to the aorta) which is why there is an impression on the vein in the contrast study

The aberrant left brachiocephalic vein joins the right SVC which then passes into the right atrium...

A Left SVC passes much more inferiorly and joins the coronary sinus (the venous drainage of the heart behind the left ventricle)

Differential diagnosis

Left SVC

Additional images

Red arrows show the position of the aorta. The aberrant left BC vein passes posterior to the aorta and is compressed by the aorta
This is where the more common Left SVC passes. It passes much more inferiorally and drains into the coronary sinus ( the big vein behind the heart which drains blood from the heart. Then the enlarged coronary sinus empties directly into the right atrium

References

  • Aberrant left brachiocephalic vein Amerasekera SSH, McGuirk SP. Aberrant left brachiocephalic vein. European Journal of Cardio-Thoracic Surgery. 2010;37(2):488. DOI: 10.1016/j.ejcts.2009.07.045.